Treatment for Dry Macular Degeneration
Treatment of Marular Degeneration Part 1
Treatment for Wet Macular Degeneration Part 2
Dr. William Rodden and Dr. Wang
http://www.retinaandvitreous.com/
What is Age-related Macular Degeneration (AMD)?
When you think of vision, you may not think about what it really means until you've started to lose some of it to AMD. But the reality is AMD is a chronic condition of the eye that causes central vision loss. It affects your central vision, which is the center area of what you see. In fact, most of the things we do everyday require central vision. This central vision loss from AMD is caused by damage to the center of the retina, otherwise known as the macula.
For some people, AMD progresses slowly. For others, it may progress faster. But AMD is a major cause of central vision loss in Americans aged 55 and older.
So when you've lived your life being able to do the things you wanted to, when you wanted to, central vision loss can leave you missing more than just your sight.
The role of the retina
The retina is the light-sensitive area found at the back of the eye that is critical to seeing. It can turn light, or an image, into electrical impulses, or nerve signals to your brain. It's your brain that works with your retina to decide what you are looking at. So if you're holding a book, it's your retina that "tells you" it's a book.
The role of the macula
The macula is located in the center of the retina. It is the area that lets you see color and fine detail, which is critical to performing everyday activities. It's the macula that helps you in tasks like reading or even cooking. So if you're reading a book, the macula allows you to see the words on each page. If you are cooking, it will help you see that the cookies are just right or are burning.
If the macula is damaged because of AMD, you'll have blurred central vision. You may also notice that straight lines seem wavy.
Who has AMD?
AMD is a major cause of severe central vision loss in Americans aged 55 and older. And, it is more common in women than men. It is estimated that 1.2 million people in the US have wet AMD. Over the next few years, the number of people to get macular degeneration is expected to grow. In fact, by 2020, approximately 3 million people may be diagnosed with advanced AMD.
The role of the retina
The retina is the light-sensitive area found at the back of the eye that is critical to seeing. It can turn light, or an image, into electrical impulses, or nerve signals to your brain. It's your brain that works with your retina to decide what you are looking at. So if you're holding a book, it's your retina that "tells you" it's a book.
The role of the macula
The macula is located in the center of the retina. It is the area that lets you see color and fine detail, which is critical to performing everyday activities. It's the macula that helps you in tasks like reading or even cooking. So if you're reading a book, the macula allows you to see the words on each page. If you are cooking, it will help you see that the cookies are just right or are burning.
If the macula is damaged because of AMD, you'll have blurred central vision. You may also notice that straight lines seem wavy.
Who has AMD?
AMD is a major cause of severe central vision loss in Americans aged 55 and older. And, it is more common in women than men. It is estimated that 1.2 million people in the US have wet AMD. Over the next few years, the number of people to get macular degeneration is expected to grow. In fact, by 2020, approximately 3 million people may be diagnosed with advanced AMD
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There are two forms of AMD—wet and dry. Dry AMD is more common than wet. In fact, more than 85% of AMD patients are diagnosed with dry AMD. Wet AMD is the more severe form of the disease and it can progress very quickly. Although only 10% of people with dry AMD will get wet AMD, it is a major cause of central vision loss in adults. About 200,000 people are diagnosed each year.
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Wet AMD is the most serious form of AMD. And, it can progress very quickly. Although only 10% of people (1 out of 10) with dry AMD will get wet AMD, it is a major cause of central vision loss in adults. About 200,000 people are diagnosed each year.
Wet AMD occurs with the abnormal growth of blood vessels in the back of the eye. These blood vessels grow specifically under your retina. As the blood vessels grow, they can leak blood and fluid, which can cause scarring on your retina and substantial damage to the macula. This leakage may result in the loss of your central vision.
The earliest symptom of wet macular degeneration is vision change. If you notice that straight lines appear wavy, or that doorframes don't seem straight, you should get an eye exam as soon as this occurs. It may be an early sign of wet AMD. Today, retina specialists can prevent vision loss from getting worse or even help you get some of your vision back. But early diagnosis is critical. If you think you have symptoms of wet AMD, see your eye doctor immediately.
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Dry AMD, the most common form, develops slowly over time. You may or may not notice vision loss in the earlier stages. In fact, many people who have dry AMD don't even notice any signs or symptoms.
Dry AMD occurs when cells and blood vessels underneath the macula break down and cause deposits called drusen. It is this drusen that can make you lose some vision.
Early diagnosis is very important when it comes to AMD. Your eye doctor will conduct tests to determine if you have AMD. And whether it is dry or wet.
STAGES OF DRY AMD:
Early dry AMD
People with early dry AMD usually have several small- to medium-sized drusen. Drusen are yellow deposits under the retina. With early AMD, there may be little or no vision loss.
It is very important to m onitor your vision regularly because dry AMD can get worse or even progress to wet AMD. You can use an Amsler grid to consistently check your vision, but it is important that you have regular eye examinations. If you notice any changes to your vision, talk to an eye doctor right away.
The Amsler grid is a basic test that may help determine if you have AMD. It is a grid of black lines on a white background with a dot in the middle.
The grid should appear to have straight horizontal and vertical lines with a dot in the center. However, if the area around the dot appears to be wavy, it may be a sign of wet AMD. If you notice any wavy lines or blurriness at all, make an appointment with a retina specialist. When doing this test, keep the following in mind:
- It is important to test each eye separately. So cover 1 eye and look at the grid with the other. Then repeat with your other eye
- Keep the grid at a normal reading distance—about 14 inches away
- Do not stare at the grid for long periods of time
- Make sure you are looking directly at the dot in the center of the grid
- If you normally wear glasses, do so while looking at the grid
- Make sure you are looking at the grid with adequate lightin.
Intermediate dry AMD
People with intermediate AMD have many medium-sized or 1 or more large drusen. As the disease progresses, the drusen become larger and softer. Some people see a blurred spot in the center of their vision and extra light may be needed for reading.
Late dry AMD
In addition to drusen, patients may develop geographic atrophy (GA). GA appears as a thinning and discoloration of the retina. Late dry AMD may progress to wet AMD if blood vessels form on the back of the eye and begin to leak fluid. About 10% of patients with dry AMD progress to the wet form.
AMD can occur in 1 eye, or in both.
Having AMD (wet or dry) in 1 eye is called "unilateral disease." If you have AMD in 1 eye, it's important for you and your eye doctor to monitor your other eye. That's because there's a good chance you will develop AMD in both eyes. For this reason, it's very important to check your eyes regularly and talk to your retina specialist about any changes to your vision.
AMD in both eyes
Having AMD in both eyes is known as "bilateral disease." In general, dry AMD occurs in both eyes, but vision can be lost in 1 eye while the other seems unaffected. That's why it is important to monitor your vision. Early detection can give you the best chance for success in treating your AMD.
Signs and symptoms of AMD—What to look for
With early AMD, you may not notice any change to your vision at all. Dry macular degeneration usually develops slowly over time with slow-progressing symptoms. But wet AMD usually develops quickly, leaving people with vision loss that is noticed suddenly. Signs and symptoms can vary from person to person and depend on the type of AMD you have.
Some advanced dry AMD symptoms may include:
- The need for brighter light when doing close work
- Difficulty adapting to low light levels
- Print appears more and more blurry (ie, newspapers, magazines, books)
- Difficulty driving
- Colors appear less bright
- Difficulty recognizing faces
- Overall haziness of vision
- A blind spot in the center of your vision
- The need to scan an object using your peripheral vision to get a complete picture
Wet AMD symptoms may progress more rapidly and may include:
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Visual distortions such as: | |
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– | Straight lines or faces appearing wavy |
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– | Doorways seeming to be crooked |
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– | Objects appearing smaller or farther away |
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General decrease in central vision | |
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A central blurry or blind spot | |
If you are aged 50 years or older, you should have regular eye exams. And, if you notice any change in your vision, you should see an eye doctor immediately. A good way to monitor your vision is to use a simple tool called an Amsler grid. You should use this tool once a week. Keep in mind that it is important to test each eye separately because a good eye can compensate for a bad eye.
The exact cause of AMD is not known, but there are a number of risk factors that may play a role. These risks include:
- Age. AMD is a major cause of central vision loss in Americans aged 55 and older. Download ist2_2969292_no_smoking_sign.jpg
- Family history/Genetics. If AMD runs in your family or you have a certain abnormal gene, you may have a higher risk.
- Gender. Women are more likely to get macular degeneration.
- Smoking. Cigarette smoking significantly increases the risk of macular degeneration.
- Obesity. Being severely overweight increases the chance that early or intermediate macular degeneration will progress to the more severe form.
- Low levels of nutrients. Low levels of minerals such as zinc, and vitamins A, C, and E may increase the risk of AMD.
- Cardiovascular disease. High blood pressure, stroke, heart attack, and heart disease with chest pain increase the risk of AMD.
- Race. Macular degeneration is more common in Whites than any other race.
If your ophthalmologist or optometrist thinks you have macular degeneration, you will most likely be referred to a retina specialist.
With early diagnosis and proper treatment, the progression of AMD may be delayed. And, the earlier it is detected, the better your chances are of keeping your vision. However, for some people, damage caused by macular degeneration can't be fully reversed.
If you have been diagnosed with wet AMD, your retina specialist will determine your treatment by looking at the growth of abnormal blood vessels and by looking at the damage to the macula. There are several different treatment options available for AMD. And, they are done as outpatient procedures—so you can go home the same day. The available treatments include:
Injections given into the eye. These are commonly called intravitreal injections. Your eye will be numbed prior to the injection, then you may feel pressure on your eye when receiving the injection. Many of these injections target the growth of abnormal blood vessels in the eye that cause wet AMD.
Hot Laser Treatment. A hot laser is beamed into the eye to burn away the abnormal blood vessels.
Photodynamic therapy (PDT). This therapy is for treating abnormal blood vessels that are located under the fovea. The fovea is at the center of your macula and provides your sharpest vision. PDT combines a cold laser with a light sensitive drug that is injected into your bloodstream. When the cold laser is focused on the macula, the drug releases substances that act to close off the blood vessels without damaging the macula.
Preventative measures. The Age-Related Eye Disease Study (AREDS) showed that taking certain supplements may reduce some risks of getting advanced AMD.
Taking a daily supplement of vitamins A, C, and E—along with beta-carotene, zinc, and copper—may help. Smokers should not take beta-carotene supplements. Talk to your doctor to see if supplements are right for you.
Be sure to discuss any medical conditions you may have, and the medications you take to treat them. And be sure to discuss your AMD treatment options with your retina specialist. He or she can help you determine which treatment is right for you.
If you've noticed changes in your vision that seem like symptoms of AMD, make an appointment with an eye doctor or retina specialist. To diagnose AMD, you need to have your eyes dilated so he or she can see the back of your eye. And be sure to review your medical history. If there are signs of AMD, your ophthalmologist will refer you to a retina specialist if you don't already have one. Since wet AMD can progress quickly, it is important to get treatment right away.
How is dry AMD diagnosed?
When diagnosing dry AMD, your ophthalmologist or retina specialist will be looking for the small yellow deposits, or drusen, found under the retina—and right near the macula. Normally, the macula has a reddish color. If there are signs of AMD, the macula may look patchy and pale.
How is wet AMD diagnosed?
To see if you have wet AMD, your retina specialist will be looking for different signs. He or she will be looking for the abnormal growth blood vessels leaking fluid in the back of your eye.
EYE TESTS THAT MAY BE PERFORMED FOR SCREENING AND MONITORING AMD INCLUDE:
Visual acuity test—the Snellen eye chart. The Snellen eye chart measures how well each eye can see. It's a group of letters on different lines. The bottom of the chart has the smallest letters. And each line has bigger and bigger letters. At the top of the chart is a big "E". The lower down you see on the eye chart (the smaller letters) the better your vision.
Amsler grid. This looks like a checkerboard with a black dot in the middle. You should cover 1 eye and stare at the black dot. While staring at the dot, you may notice that the straight lines seem wavy. Or, it may seem like some of the lines are missing. If the grid seems blurry or wavy, it may mean that you have wet AMD.
Dilated eye exam. First, drops are put in your eye. The drops help to widen (dilate) the pupils. Then, using a special magnifying lens, your eye doctor can look at your retina and optic nerve. Once the exam is over, your vision may be blurry. This will go away after a few hours. This test is important to diagnose wet AMD.
Tonometry. This test is done to determine the pressure within the eye, or the intraocular pressure (IOP). A tonometer exerts a little pressure on the front of the eye to do so. This is usually included as part of a full eye exam.
Fluorescein angiography (FA). For this test, a special dye is injected into your arm. As the dye passes through the blood vessels in your retina, pictures are taken of the back of your eye. This test lets an eye doctor see the blood vessels of the retina, which is critical to assessing your AMD. Since it's abnormal blood vessels that grow under the center of your retina in wet AMD, this test is often very helpful. Most people do not experience any pain with FA.
Optical coherence tomography (OCT). This test is similar to an ultrasound but it uses light instead of sound to create detailed images of your retinal tissue. The pictures that are created in OCT are clear and detailed. With OCT, your eye doctor can see any changes in eye tissues, including the macula, and determine treatment. Most people do not experience any pain with OCT.
If you find out you have wet AMD...
There are some things you can do. First, make sure you are seeing a retina specialist. These are the doctors that specialize in treating wet AMD. Then, get educated about AMD and its treatments. These days, your eye doctor can do even more to prevent your vision from getting worse. In many cases, he or she can offer you LUCENTIS® (ranibizumab injection)—an FDA-approved treatment shown to improve or maintain vision in wet AMD. Finally, ask for help. Reach out to family and friends who want to help you. If you need to be driven to an appointment, be direct and ask someone to drive you. There may be support groups in your area. Your eye doctor may be able to put you in contact with support groups and other assistance programs.
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Print out this page and answer the questions to find out if you or a loved one may be at risk for AMD. Be sure to review your answers with your eye doctor. |
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